Patient Forms

The following printable patient form is provided for your convenience. Print and complete the patient form at your leisure and save time before your appointment. Our Privacy Practices are also available for you to read online.

The printable forms are in .pdf format. You will need Adobe Acrobat Reader to view and/or print these files.

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Printable Patient Information Sheet

Insurance Coverage

We are participating providers for many insurance and vision plans. Whether we are in-network or out-of-network for your plan, we are happy to file most claims for you. If you do not see your plan listed below, contact our office at (913) 256-2176. Our staff will be glad to assist you in determining your insurance coverage.

• Aetna
• Blue Cross Blue Shield of Kansas
• Blue Cross Blue Shield of Kansas City
• Children's Mercy
• Coventry Healthcare
• Freedom Network
• Medicare
• Superior Vision Plan
• TXIX
• United Healthcare
• Vision Service Plan